Relapse is first to be documented 1 full year after outbreak became public

Oct. 5, 2013

Written by

Walter F. Roche Jr.

The Tennessean

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Former patients with questions or concerns should contact the Infectious Diseases Clinic at Saint Thomas West Hospital at 615-222-6611.

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An unidentified victim of the fungal meningitis outbreak has suffered a recurrence a full year after the outbreak, prompting an immediate effort by a Nashville hospital to contact other known victims to detect other possible relapses.

The recurrence was acknowledged late Friday by Rebecca Climer, spokeswoman for Saint Thomas Health, who said the hospital is in the process of contacting the original victims to ask about their current status.

“The patient was admitted to Saint Thomas West Hospital on Oct. 3 and is now receiving appropriate treatment at the hospital,” Climer said in a prepared statement.

She said the patient had contracted fungal meningitis in the original outbreak linked to receiving a contaminated steroidal injection.

The statement came after an inquiry by The Tennessean after it received a call from one of the original patients who had been called by the hospital.

“As a precautionary measure,” Climer wrote in the statement, “Saint Thomas West Hospital staff is currently contacting former patients previously diagnosed with fungal meningitis to inquire about their health status and urge them to be alert to the following possible symptoms.”

She said the symptoms include persistent and severe headache, worsening back pain and unexplained fever.

Karen Potts of Columbia said that she had two of those symptoms and that she was contacted by the hospital. She said she is scheduled to go in for a checkup in 10 days.

She said the caller told her that a patient had suffered a relapse and she was asked if she had any of the symptoms.

Climer said that for those displaying the symptoms of a relapse, “Saint Thomas West Hospital will provide appropriate medical services, as needed.”

The disclosure comes a year after news of the outbreak became public. Sixteen patients treated in Tennessee died and 153 were sickened. Nationally, 64 patients died while 750 were sickened.

The outbreak has been blamed on a now-closed Massachusetts drug compounding firm that sent out thousands of vials of fungus-tainted methylprednisolone acetate.

Checkups requested

Attorneys representing clients who have filed suit over the outbreak reported that their clients had been contacted by the hospital and some were asked to come in for a checkup.

Attorney Randy Kinnard said one of his clients called to report being asked to come in for a checkup

Mark Chalos, another plaintiff attorney, said one of his clients was contacted and told that all affected patients were being advised to come in for an exam as soon as possible. That same client said the caller indicated there was more than one relapse case, Chalos said.

William Leader, who also represents several victims, said a client of his was called and just asked about current health status.

The local patients received the spinal injections at the Saint Thomas Outpatient Neurosurgical Center in Nashville, one of three Tennessee facilities to purchase spinal steroids from the New England Compounding Center. The neurosurgical center is owned in equal shares by the Saint Thomas Health Network and the Howell Allen Clinic.

Though relapses or recurrences have been reported, they are more likely to occur within a few months of the original infection. The current case is the first to be reported a full year after the outbreak became public.

In an article published in June in the New England Journal of Medicine, physicians from Virginia and the U.S. Centers for Disease Control and Prevention reported on the case of an 80-year-old man who became ill in early October and suffered a recurrence in March.

“This shows the possibility for relapsed infection among patients after more than four months of antifungal therapy,” the study states.

Dr. William Schaffner, who heads the Department of Preventive Medicine at Vanderbilt University Medical Center, said recurrences “have been our concern all along.”

“I’m sure that it’s very concerning to the patients and their families and physicians,” Schaffner said. “We would hope that this doesn’t indicate more recurrences will follow.”

Follow-up study

Under a contract awarded by the CDC earlier this year, a follow-up study on the fungal meningitis victims is being conducted by Dr. Peter Pappas at the University of Alabama at Birmingham. In a telephone interview Friday, Pappas said it was too early to draw conclusions about the relapse.

He said that Saint Thomas was one of the focal points of the study, which is just getting underway. He said recurrences are “fairly common” with fungal infections.

Officials at the U.S. Food and Drug Administration and the CDC said they could not immediately respond to questions due to the budget crisis and the resulting lack of staff.

Asked if they were aware of the relapse case, Tennessee Health Department spokeswoman referred questions to Saint Thomas.

“Physicians know the patients they are treating and will make individual decisions regarding patient care,” Shelley Walker, the spokesman, said in an email response to questions.